Massachusetts insurers are increasingly wielding their financial clout to reward doctors and hospitals that take steps to reduce errors and improve management of some of the most expensive diseases — and by extension punish doctors and hospitals that fall short in key quality areas.

Insurance companies stand to save huge sums of money. Just eliminating hospital-based infections could save up to $400 million a year in Massachusetts, one group estimates — and that’s a single, especially egregious, problem.

Hospitals and doctors that reach benchmarks established with insurers stand to see reimbursements increase in the short term and patient referrals increase over time. Quality will become a “strategic advantage,” said Christine Schuster, CEO of Emerson Hospital in Concord.

On the other side of the equation, health care providers that fail to meet standards of care stand to lose business as insurers steer members elsewhere.

Pegging reimbursement to outcome stands the traditional system on its head. In Massachusetts, doctors and hospitals for the most part have been paid by the procedure. The more they do, the more they make. The only exception was a short-lived system called capitation that came into favor during the 1990s and saw insurers pay lump sums to provider groups for each patient they oversaw.

Against that backdrop, the idea that good care would fetch good reimbursement and bad care would fetch little or none is revolutionary.

“It’s a bit of a paradigm shift, but it’s the right thing to do for patients,” said Schuster, whose hospital has fared well in national quality examinations.

The specific programs vary widely.

A popular initiative financed by Blue Cross and Blue Shield of Massachusetts and developed in collaboration with the Massachusetts Hospital Association puts boards of trustees through intensive training on preventing errors.

Emerson’s trustees — nearly two dozen management consultants, venture capitalists, volunteers and medical professionals — assembled at Nashawtuc County Club to learn how errors occur and what steps can be taken to minimize them.

One of the biggest revelations for board members was realizing how they can encourage clinical changes, said Chairman John Lowe, a professor at Simmons College. “Boards have always had the ability to do more in quality. We didn’t realize we had the tools right there to do it.”

An example of the board flexing its muscle has been an increase in the number of discussions surrounding the qualifications for physicians who practice at the hospital, he said.

The Emerson trustees have formed a committee dealing only with quality. Its members are in the processing of identifying a few specific measures of quality “so we can hold management accountable,” Lowe said.

He acknowledges there could be thorny discussions in the future, such as what to do when too many of one doctor’s patients suffer infections.

Giving an insurer access to a hospital’s trustees could also put its administrators in awkward positions.

Schuster said hospital administrators traditionally view the role of trustees as being fiduciary.

But as more insurers peg payments to clinical outcomes, the era when financial performance and medical results were distinct is drawing to a close, she said.

“People are going to start to pay for outcomes,” Schuster said. “So it’s really in the board’s interest to understand: Why didn’t we get paid for these not-too-good outcomes?”

Under the Blue Cross and Blue Shield error-prevention program for trustees, a hospital might get between $50,000 and $100,000 to run the initial sessions.

“Bonus payments” will follow if institutions meet certain clinical goals, such as reducing infections, said Andrew Dreyfus, executive vice president of health care services at Blue Cross. “They get progressively more demanding and outcome-oriented.”

While the program has been widely heralded, the idea surprised many future participants.

“Admittedly, that was kind of a novel request. ... Trustees are carefully guarded,” said Karen Nelson, senior vice president of clinical affairs at the hospital association.

In another example of an insurer linking reimbursements and outcomes, Harvard Pilgrim Health Care is encouraging physicians to use cost-effective laboratories, said Dr. Rick Weisblatt, vice president of network services. “There’s a huge variation in lab costs.”

Because converting to electronic medical records can be expensive for practices, Harvard Pilgrim offers financial incentives that help justify switching over, Weisblatt said.

Also, doctors are given financial incentives for meeting clinical standards around some especially expensive, and relatively common, conditions: Do they follow up with patients diagnosed with depression? Are asthma patients on the right medications?

Hospitals are rewarded in large part if they perform better than their peers in key clinical measures, such as preventing pneumonia.

About 25 percent of Harvard Pilgrim’s members come under traditional contracts, Weisblatt said, while 60 percent are treated by doctors in pay-for-performance contracts.

“When we look at the two, we don’t see a difference (in outcomes),” he said.

Tufts Health Plan has been engaged in similar initiatives.

“We have seen improvements in both quality and efficiency — however, I think it’s time to go to the next level,” said Tufts CEO James Roosevelt.

In addition to pushing for more transparency throughout the system, he said, Tufts will take steps to create tiers of providers based on “cost and quality.”

Ultimately, Tufts members could have incentives to go to those hospitals and doctors that meet the plan’s standards.

While the insurers push forward with quality standards, the Massachusetts Medical Society, a physicians organization, is “early in the process” of developing its own proposed quality measures, said Dr. Bruce Auerbach, the group’s president. No timetable has been released.

The Medical Society is in favor of clinically proven standards such as requiring certain responses when patients complain of chest pain, Auerbach said, but members oppose other standards that fail to adjust for factors such as whether patients show up for tests ordered by their doctors.

“There still are questions about the degree to which some of these programs ... are actually using evidence-based, vetted measures,” he said.